2 Objectives At the end of this lecture the students will be able to:Explain the meaning of schizophreniaDiscuss symptoms of schizophreniaDifferentiate and contrast between etiological factors related to schizophreniaDetermine schizophrenia subtypesAssess client with schizophreniaDevelop a nursing care plan for a client with schizophreniaAL-barrak 1430

3 Outlines Definition Etiological factors related to schizophreniaSymptoms of schizophreniaSubtypes of schizophreniaAssess client with schizophreniaDevelop a nursing care plan for a client with schizophreniaAL-barrak 1430

5 What are the different between neurotic & psychoticDelusion & hallucinationEnvironmentinsight LackInsightCan not stop medicationMedication Can stope.g. schizophreniae.g. anxiety & stresshospitalization NeedClinicalAL-barrak 1430

6 IntroductionSchizophrenia is a condition that exists in all cultures and in all socioeconomic group .It is estimated that 1% of the general population suffer from schizophrenia .people with schizophrenia occupy approximately 50% of the hospital beds for the mentally ill .AL-barrak 1430

7 DefinitionSchizophrenia is a major psychotic disorder marked by a profound withdrawal from interpersonal relationship and cognitive and perceptual disturbances that make dealing with reality difficult.It is characterized by splitting of normal links between perception, mood, thinking ,behavior and contact with reality .AL-barrak 1430

8 Schizophrenia is a group of psychotic disorders that interfere with thinking and responsiveness. It is a disease of the brain. The term schizophrenia, which means "split mind," was first used in 1911 by Swiss psychiatrist Eugen Bleuler to categorize patients whose thought processes and emotional responses seemed disconnected.AL-barrak 1430

16 Schizophrenia: Some Facts and StatisticsFigure The natural history of schizophrenia: a 5-year follow-up. Copyright 1989 by Cambridge University Press. Reprinted with the permission of Cambridge University Press.

25 Causes of Schizophrenia: Other Neurobiological InfluencesFigure Location of the cerebrospinal fluid in the human brain. This extracellular fluid surrounds and cushions the brain and spinal cord. It also fills the four interconnected cavities (cerebral ventricles) within the brain and the central canal of the spinal cord.

28 C. Genetic FactorsThe risk for inheriting schizophrenia is 10 % in those who have one immediate family member with the diseaseAbout 40% if the disease affects both parents and an identical twin.About 60% of people with schizophrenia have no close relatives with the illness.AL-barrak 1430

29 Causes of Schizophrenia: Findings From Genetic Research (cont).Figure Risk for schizophrenia among children of twins.

35 2. Environmental factorsa. InfectiousThe viruses as a cause of schizophrenia such as living in crowded conditions.b. Seasonal factorsThe risk for schizophrenia worldwide is 5 – 8 % higher for those born during winter and spring, when colds and viruses are more prevalent. Pregnant Mother's Exposure to Viruses.The mother's exposure to viral infections such as rubella, measles, chicken pox,& toxoplasmosisAL-barrak 1430

39 a- Psychoanalytic and developmental theories : Psychoanalytic theory states that there are distortions in the mother-child relationship, so that the child is unable to progress beyond dependence.AL-barrak 1430

40 b- Learning theoryChildren learn what they are exposed to on a daily basis.According to learning theory, the irrational ways of handling situations, the distorted thinking, and the deficient communication patterns of persons with schizophrenia are a result of poor parental models in early childhood .AL-barrak 1430

41 ******c- Family theory ********1. Double binde.g. I love my san I leave him (say thighs do opposite)2. Scapegoate.g. Put all the problem to one person in my family3. Eschewed familye.g. Father stay in the house & mother are working (opposite role)4. Schismatic familye.g. Father & mother all the time have (conflict)AL-barrak 1430

42 Questions review List the causes of SchizophreniaExplain Eugen Bleuler – Introduced the term “schizophrenia” or “splitting of the mind”; the 4 As:Discuss Family theoryAL-barrak 1430

43 Symptoms of schizophreniaSchizophrenia affects different people in different ways. Not everybody will experience the same symptoms, nor are they always to the same degree.Two types of symptoms are distinguished in schizophrenia – they are classified as positive and negative symptoms.AL-barrak 1430

45 b. Hallucinations can occur in any of the five senses but the most common are auditory.For example, the person may hear voices repeating their thoughts, in conflict, commenting on their actions telling them what to do (command hallucinations).Hallucinations of any form occur in over 70 per cent of people who experience psychotic illnesses.Auditory hallucinations occur in approximately 50 per cent of people with schizophrenia, while visual hallucinations occur in 15 per cent.AL-barrak 1430

46 Disorganized Thinking This is usually expressed through abnormal spoken language.For example, the person's conversation jumps from one topic to another, new words may be created, the grammatical structure of language breaks down and speech may greatly speed up or slow down.Disorganised Behaviour Disorganised behaviour can lead to problems in conducting the activities of daily living such as organizing meals and maintaining hygiene.AL-barrak 1430

47 Catatonic BehaviourThis refers to states of muscular rigidity and immobility, stupor and negativism,The person may hold fixed or bizarre bodily postures for extended periods of time and resist any effort to be moved.AL-barrak 1430

49 Withdrawal, Loss of Motivation & Ambivalence (Avolition)People experiencing avolition may be negligent grooming, personal hygiene, have difficulty making decisions & have difficulty persisting at work, school or family tasks.AL-barrak 1430

50 Loss of Feeling or an Inability to Experience Pleasure (Anhedonia)Lack of interest in social or recreational activities ,failure to develop close relationships.Poverty of Speech (Alogia)The person's amount of speech is greatly reduced & people showing signs of alogia may be slow in responding to questions or not respond at all.AL-barrak 1430

51 Flat Presentation (Affective Flattening) This can be indicated by unchanging facial expressions, poor or no eye contact, reduced body language and decreased spontaneous movements.Cognitive Impairmentscognitive dysfunction is often present in people with schizophrenia is associated with cognitive impairments including problems with attention, concentration and memory.AL-barrak 1430

52 There are five major subtypes of ****schizophrenia.Paranoid schizophreniaDisorganized schizophreniaCatatonic schizophreniaUndifferentiated schizophreniaschizophrenia ResidualAL-barrak 1430

60 Catalepsy (Posturing) Waxy flexibilityMaintenance of imposed postures e.g. raising the head of the patient from the pillow, or the arm up) *absence of fatigueCatalepsy (Posturing)Is sustained immobility (patient initiates position by herself)AL-barrak 1430

64 5. Residual schizophreniaIf an individual has had at least one acute episode of schizophrenia and is now free of prominent positive symptoms, but has some negative symptoms he is diagnosed as suffering from residual schizophrenia .The usual signs of the illness areIllogical thinking,Loosening of associationsEmotional bluntingSocial withdrawalEccentric (bizarre) behaviorAL-barrak 1430

70 5. A client was diagnosed with paranoid schizophrenia twenty years ago5. A client was diagnosed with paranoid schizophrenia twenty years ago. The client no longer displays persecutory delusions, but lacks social and self-care skills and is unable to work. What subtype of schizophrenia is the client displaying? a. Disorganized b. Paranoid c. Residual d. UndifferentiatedAL-barrak 1430

74 Assessment the common delusion includes: 1.Alteration of thought (delusion )the common delusion includes:Paranoid delusionIdeas of referenceDelusion of grandeurDelusion of jealousyDelusion of persecutionSomatic delusionPositive SymptomsAL-barrak 1430

75 Other delusion observedThought broadcasting: the belief that one’s thoughts can be heard by othersThought insertion, the belief that thoughts of others are being inserted into one’s mindThought withdrawal, the belief that thoughts have been removed from one’s mind by an outside agencyDelusion of being controlAL-barrak 1430

76 Lose association: the thought process becomes illogical & confused.Neologisms: made up words that have a special meaning to the delusional person .Concrete thinking: an overemphasis on small or specific details & an impaired ability to abstract.Autistic thinkingClang associations: the meaningless rhyming of a word in a forceful way.Word salad: a mixture of words that is meaningless to the listener.AL-barrak 1430

77 1. Alteration PerceptionHallucinations are the major examples of alterations in perception in schizophrenia, especially auditory hallucinations,AL-barrak 1430

78 Auditory hallucination in form of voices may seem to come from outside or inside the person’s head. The voice may be familiar or strange, single or multiple. Voices speaking directly to the person or commenting on the person’s behavior are most common in schizophrenia. A person may believe the voices are from. God ,the devil, dead relatives, or strangers.AL-barrak 1430

79 Commanding hallucinations Must be assessed, because the “Voices” may command the person to hurt himself or others.For examples, a client might state “the voices” are telling him to “ jump out of the window” or “take a knife & kill my child”.2. Commenting hallucinatione.g. why does not clean SarahAL-barrak 1430

80 What are the characteristic of schizophrenia Commanding & commenting auditoryAL-barrak 1430

81 Alteration behaviorBizarre & agitated behavior is associated with schizophrenia and may take a variety of forms.StereotypedStuporWaxy flexibilityAL-barrak 1430

82 Negative symptomsThese symptoms are that most interfere with the individual’s adjustment and ability to survive.A volitionAnhedoniaFlat affectWithdrawalHe couldn't take decisionsNeglect basic hygiene and need help with everyday activities.AL-barrak 1430

88 Important noteTypes of hallucination in schizophrenia patient’s command & commentedAll the types of schizophrenia start early except Paranoid state after age 40 years old.Drugs schizophrenia takes on long liveAL-barrak 1430

89 Goals Able to hold conversation without hallucinating.Able to hold conversation without hallucinating.Remains in group activities.Attends to the task at hand (e.g. group process , recreational or occupational therapy activity ).States that hallucinations are under controlAL-barrak 1430

91 Conclusion Schizophrenia is a severe mental disorder characterized by two kinds of symptoms; Positive symptoms ( thought disorder, hallucinations & delusions, ) & Negative symptoms – impairment in emotional range, energy, and enjoyment of activities. For a formal diagnosis, these symptoms must persist for at least one month and usually result in severe impairment in job and/or social functioningAL-barrak 1430

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